1/3. Fully endoscopic vascular decompression of the glossopharyngeal nerve.Microvascular decompression of the glossopharyngeal nerve is an effective treatment of patients with glossopharyngeal neuralgia in whom compression of the nerve by a blood vessel is implicated in the pathogenesis of the disease. The standard surgical technique uses a binocular operating microscope for intra-operative visualization. Growing experience with posterior fossa endoscopy, however, has suggested that endoscopes may provide more comprehensive anatomical views of cerebellopontine angle. This report describes the case of a patient suffering from glossopharyngeal neuralgia who underwent fully endoscopic vascular decompression of the glossopharyngeal nerve. During this procedure the endoscope was used to survey the posterior fossa, guide the placement of insulating sponges, and conduct a final assessment of the intervention. We found the endoscope ideally suited to the constricted operating space of the posterior fossa, allowing for accurate localization and careful separation of the pathological vascular conflict with minimal brain retraction and no damage to surrounding structures. The versatility of endoscopy allows for superior visual appreciation of neurovascular conflicts in the posterior fossa. To date, endoscopy has primarily been used to supplement microscopy in cranial nerve decompression surgery. This report demonstrates how the endoscope can be used as the sole imaging modality in glossopharyngeal nerve decompression, with excellent results.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/3. Extracranial internal carotid artery aneurysm presenting as symptomatic hypoglossal and glossopharyngeal nerve paralysis.Aneurysms of the extracranial portion of the internal carotid artery are rare, particularly in young patients. They usually develop following trauma, or secondary to infection involving the parapharyngeal space that extends to the vessel wall. This is a case of an internal carotid artery aneurysm presenting acutely following chiropractic neck manipulation with hypoglossal and glossopharyngeal nerve palsy. The imaging findings and subsequent operative management are described.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/3. Traumatic dissection of the internal maxillary artery associated with isolated glossopharyngeal nerve palsy: case report.OBJECTIVE AND IMPORTANCE: Spontaneous or traumatic dissection of the internal carotid artery with resultant lower cranial nerve palsies is well documented. However, dissection of the external carotid artery with lower cranial palsies has not been reported previously. CLINICAL PRESENTATION: A 42-year-old man experienced an epidural hematoma as the result of a fall and underwent a craniotomy and hematoma removal. Subsequently, he developed dysgeusia and difficulty in swallowing. brain magnetic resonance imaging showed a dilated linear structure, with isosignal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images. Strong enhancement was seen on postcontrast T1-weighted images, indicating a dissected internal maxillary artery. This was confirmed on selective angiography of the left common carotid artery. INTERVENTION: Guglielmi detachable coils were introduced into the false lumen of the dissected artery. Subsequently, 0.5 ml of glue mixed with Lipiodol (Lafayette Pharmacal, Lafayette, IN) was packed into the remnant of the false lumen. Repeat angiograms demonstrated complete occlusion of the dissected vessel. The patient's postoperative course was uneventful, and the neurological deficits gradually improved. CONCLUSION: We describe the first reported case of internal maxillary artery dissection and pseudoaneurysm presenting with isolated glossopharyngeal nerve palsy. The association between cranial nerve palsy and dissection of the external carotid artery branch may be the result of a compressive mechanism, as suggested by its anatomic relationships, the characteristics of the dissection, and the good prognosis. Endovascular embolization of the external carotid artery dissection and pseudoaneurysm is suggested as an effective therapeutic method for improving or alleviating neurological deficits produced by mass effect.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |